I did it.
Yesterday I bit my tongue so hard I nearly bit it off, but I did it. And with a smile.
A patient of mine, who is an executive in health care, was in for a cardiac screening test. After I went over her results, we started talking about insurance and coverage of preventive health testing. Blah blah blah.
Then she said IT.
She said, and I quote: "Now what is really ridiculous is coverage of...what do you call it? People having babies? No, not people having babies, that's ok, but people who can't have babies and do to that...what do you call it? Insemin....artificial...in vitro....?"
I interrupted and said "In vitro fertilization?"
"Yes! That's it! They pay for that...ummmm, excuse me? I think that's insane. I refuse to pay for that!"
I could feel my face freeze in a ridiculous smile. I thought there must be a hidden camera somewhere in my office.
I managed to stammer: "Well I don't think many pay for it, actually."
Her reply: "Oh yes they do! And it's ridiculous."
I didn't say anything else. After all, she was my patient and if the conversation had continued, I likely would have decked her, called her out on her bad dye job and stupid 80's hairdo, and then been fired. How about a little compassion for those of us who aren't naturally fertile? Sheesh.
Which brings me to something else...and I am warning you, I am NOT judging anyone for selecting to transfer certain numbers of embryos...I'm just talking here.
Someone with whom I work had their first IVF recently. They are young and otherwise unexplained. They chose to transfer two very good quality blasts. They got pregnant with twins. Their twins were born way too early and have spent considerable time in the NICU. One has had multiple surgeries.
I heard another coworker talking about how we (my employer) will be dropped by our insurance company because this person's twins have bankrupted us. It's true, they probably have. I cannot imagine the cost of two babies in the NICU for several months. The coworker was saying that it's not fair.
Let's take a step backwards here.
Our insurance doesn't cover IVF. If they had, I can guaran-damn-tee you that couple would not have transferred two blasts. The doctors who recommended it was going against recommended guidelines. In medicine, guidelines are gold. They are the standard. I practice to guidelines every.single.day because they are based in science and research and outcomes studies.
But when you have zippo coverage for IVF, you take bigger risks and doctors allow it, encourage it even. You transfer more than might be the recommendation because you cannot afford--literally--to fail. It's understandable. We transferred four embryos on our last IVF and I was 34 years old. Granted, we were not a typical couple--we'd have four failures prior with nary a chemical, and our embryos weren't stellar. But even still, guidelines would say transfer no more than three. So I completely understand the need to transfer 'more than enough' just to be sure. Just to up the odds. Because I did it myself.
CC.R.M. has an unacceptable multiples rate. Multiples should never, ever be the goal. I am not saying all multiple pregnancies are doomed to be costly and risky and all of that, but the goal should always be healthy singleton pregnancies. But who's going to call them out? They want the success rates, too, and I don't think they can force women do to single embryo transfers. I do know they limit the number of CGH normal embryos they will transfer, thank God for that.
So back to my stupid stupid patient and my coworker: do they ever really think? Think that if IVF were covered we might not be faced with desperate couples making decisions that stray from established guidelines, and that health care costs would actually be lower in the end?
Of course not.
Because they're stupid. And annoying. And I'm really ashamed I couldn't have spoken my mind with my patient, but alas, I couldn't.
But maybe if they could watch my video (I reposted my link to our IVF music video) they would see that we're just two human beings, in love, wanting a family, and having to go to measures no one ever should to have one.
And it didn't cost anyone else a blessed cent, we fronted it all ourselves. So there.
3 years ago